Young-In Yoon1, Sung-Gyu Lee1, Deok-Bog Moon1, Chul-Soo Ahn1, Shin Hwang1, Ki-Hun Kim1, Tae-Yong Ha1, Gi-Won Song1, Dong-Hwan Jung1, Gil-Chun Park1, Dong-Sik Kim2, Suk-Jung Choo3. 1. Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. 2. Division of HBP Surgery and Liver Transplantation, Department of Surgery, Korea University Medical Center, Korea University Medical College, Seoul, Republic of Korea. 3. Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Abstract
OBJECTIVE: We aimed to describe our living-donor liver transplantation (LDLT) surgical technique and its long-term patency for patients with Budd-Chiari syndrome (BCS) and retrohepatic inferior vena cava (IVC) obstruction that extends up to the atrium. BACKGROUND: From a technical perspective, LDLT for BCS with an IVC obstruction up to the right atrium is one of the most challenging surgical procedures. Consequently, the optimal surgical technique for patients with BCS has not yet been elucidated. METHODS: A durable LDLT technique without piggy-back hepatectomy was designed using a large-caliber synthetic interposition vascular graft between the right atrium and the infrahepatic IVC for reconstructing the hepatic outflow tract in patients with BCS. RESULTS: Between May 2006 and May 2017, 5 of 17 BCS patients who underwent LDLT required the described technique. All patients with a median follow-up of 10.5 years (range, 9.2-11.5 years) demonstrated the patent IVC grafts and no recurrence of BCS. CONCLUSIONS: Our refined technique does not require unnecessary and dangerous dissection of the diseased IVC, and eliminates the residual suprahepatic vena cava with the possibility of BCS recurrence by connecting the graft to the healthy atrium.
OBJECTIVE: We aimed to describe our living-donor liver transplantation (LDLT) surgical technique and its long-term patency for patients with Budd-Chiari syndrome (BCS) and retrohepatic inferior vena cava (IVC) obstruction that extends up to the atrium. BACKGROUND: From a technical perspective, LDLT for BCS with an IVC obstruction up to the right atrium is one of the most challenging surgical procedures. Consequently, the optimal surgical technique for patients with BCS has not yet been elucidated. METHODS: A durable LDLT technique without piggy-back hepatectomy was designed using a large-caliber synthetic interposition vascular graft between the right atrium and the infrahepatic IVC for reconstructing the hepatic outflow tract in patients with BCS. RESULTS: Between May 2006 and May 2017, 5 of 17 BCS patients who underwent LDLT required the described technique. All patients with a median follow-up of 10.5 years (range, 9.2-11.5 years) demonstrated the patent IVC grafts and no recurrence of BCS. CONCLUSIONS: Our refined technique does not require unnecessary and dangerous dissection of the diseased IVC, and eliminates the residual suprahepatic vena cava with the possibility of BCS recurrence by connecting the graft to the healthy atrium.
Authors: V Gunasekaran; M S Reddy; A Rammohan; N Shanmugam; D Thiruchunapalli; R G Kanagavelu; I Kaliamoorthy; M Rela Journal: World J Surg Date: 2022-09-07 Impact factor: 3.282